diagnostic imaging on intracranial atherosclerotic stenosis
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Diagnostic Imaging on Intracranial Atherosclerotic Stenosis

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Diagnostic Imaging on Intracranial Atherosclerotic Stenosis. Eduardo Freire Mello Department of Interventional Neuroradiology Hospital Espanhol, Salvador - BA, Brasil [email protected] Introduction.

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diagnostic imaging on intracranial atherosclerotic stenosis
Diagnostic Imaging on Intracranial Atherosclerotic Stenosis
  • Eduardo Freire Mello
  • Department of Interventional Neuroradiology
  • Hospital Espanhol, Salvador - BA, Brasil
  • [email protected]
introduction
Introduction
  • Intracranial Atherosclerotic Disease accounts for 6 - 10% of all Ischemic Strokes in whites, and may be responsible for 22 - 26% of all IS in Asians
  • 15% risk of recurrent stroke per year
  • Under-recognized cause of stroke
  • Recent advances on clinical and interventional treatment
  • Accurate radiological diagnosis and quantification of the lesions is crucial for treatment planning
slide3

So, non-invasive methods are required !

DSA
  • Gold-standard, but....
  • Most expensive, invasive and time consuming
  • Stroke risk of 0,7% with permanent disability
transcranial doppler
Transcranial Doppler
  • Least invasive and expensive test
  • Highly operator-dependent
  • Low reproducibility
  • Not technicaly feasible in all patients
  • Not possible to image every vessel
mra x cta
MRA X CTA
  • CTA is less susceptible to motion artifacts and less dependent on hemodynamic effects
  • Approach of all proximal portions of the intracranial vasculature with a proper CTA examination and processing techniques
  • Some recent studies have compared the accuracy of MRA and CTA, alone or combined, to DSA (gold-standard)....
slide6
In 2002 Hirai et al. demonstrated that:
    • MRA alone < CTA + MRA
    • MRA alone has a lower spatial resolution as compared with CTA or DSA, and can cause overestimation of stenosis
    • Accuracy of MRA + CTA ≅ DSA in measuring stenosis and detecting occlusions of the major intracranial arteries

AJNR Am J Neuroradiol 23:93-101, January 2002

slide7

In 2008 Nguyen-Huynh et al. evaluated the accuracy of CTA for Intracranial Atherosclerotic Disease, comparing to DSA:

  • CTA detected large artery occlusion with 100% sensitivity and specificity
  • For detection of > 50% stenosis CTA had 97,1% sensitivity and 99,5% specificity, and a NPV of 99,8%

Stroke. 2008; 39:1184-1188

  • In 2005 Bash et al. compared CTA with MRA, using DSA as a gold-standard:
    • CTA has a higher sensitivity, specificity and PPV for the evaluation of intracranial stenoocclusive disease

AJNR Am J Neuroradiol 26:1012-1021, May 2005

slide8
In 2007 Villablanca et al. compared MDCT Angiography to DSA for detection and quantification of small intracranial arteries, and concluded:
    • MDCT Angiography depicted 90% or more of all examined small intracranial arteries detected with DSA
    • The smallest arterial size reliably detected with CTA was 0,7mm versus 0,4mm for DSA

AJR 2007; 188: 593-602

slide9
CTA`s disadvantages
    • Radiation exposure
    • Time and skill involved in image processing
    • Use of contrast material
    • Possible venous contamination in a region of interest
    • No significant flow information
conclusion
Conclusion
  • CTA seems to be more accurate than MRA to evaluate intracranial atherosclerotic stenosis
  • CTA can be relatively comparable to DSA and presents fewer risks, less costs, is more frequently available and is highly accurate
  • CTA may be considered as the primary study in the setting of suspected intracranial atherosclerotic stenosis
ad